conscious, usually with barbiturates or benzodiazepines (Quill, Lo and Brock, 1997, p. 2100). Again, death may take weeks to come, and usually results from starvation or dehydration, or some other intervening complication. Terminal sedation can be interpreted here not as the cause of death per se, but as a means to keeping the patient comfortable while dehydration and starvation occur. The Supreme Court recently approved of this method of treatment for terminal patients, and the practice is carried on openly in many palliative care and hospice groups with a reported frequency ranging from zero percent to 44 percent.
Terminal sedation offers several advantages. It can be carried out in patients with severe physical limitations; the time delay between onset and death permits reassessment by members of the family and the health team; physicians can ensure that the patient's decision is informed and voluntary before beginning the procedure; and in patients who lack decision-making capacity but are seen to be suffering intolerably, the surrogate or family can make the decision. Nevertheless, the method remains controversial.
Physician-assisted suicide has probably received the most exposure because of the very public actions of Dr Jack Kevorkian. In this scenario, the physician usually prescribes a large dose of barbiturates with which a patient can end his or her life (Quill, Lo, Brock, 1997). While the physician may be seen as morally responsible for the suicide, the patient actually carries it out. The physician is needed to make available to the patient the necessary medications to end life. Some physicians are more comfortable with this procedure, because while they supply the means, it is the patient who has to make the final decision as to whether or not to take the medication and when to do so.
Physician-assisted suicide has some disadvantages. Self-administration does not guarantee competence or voluntariness...